Senators Support Medicaid Solution for Puerto Rico

U.S. Senators Marco Rubio (R-FL), Bob Menendez (D-NJ), Rick Scott (R-FL), and Richard Blumenthal (D-CT) sent a letter to Senate Committee on Finance Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) calling for a long-term solution to Puerto Rico’s Medicaid underfunding.

Puerto Rico is facing another Medicaid cliff in September when it is scheduled to lose as much as 90% of its current funding for Medicaid.

Medicaid in Puerto Rico

About 1.5 million of Puerto Rico’s 3.2 million residents rely on Medicaid for healthcare. However, Medicaid in the territories is not the same as Medicaid in the States. Federal funding for Medicaid in the States is based on the needs in those states; when the need is greater, the funding expands to meet those needs. In Puerto Rico, there is a cap on federal spending.

Even in the aftermath of Hurricane Maria, subsequent earthquakes, and the COVID-19 pandemic, Puerto Rico received less funding that it would have as a state of the United States. The result is that the territory must beg Congress for additional funding every couple of years to eke out sufficient funds to meet basic healthcare needs of its residents. Again this year, the government of Puerto Rico faces a Medicaid cliff — that is, a shortfall in funding for the Medicaid program.

The letter by the four Senators begins by reminding the readers of this situation.

“Without congressional action, Puerto Rico will face a Medicaid fiscal cliff on September 30, 2021 that will lead to a significant shortfall in Fiscal Year 2022,” the authors wrote. “Under Section 1108 of the Social Security Act, territorial Medicaid programs, unlike state programs, are subject to an annual statutory cap. Most recently, in 2019, Congress acted to increase the limit of the Section 1108 cap for a period of two years. Should that expire without a legislative fix, Puerto Rico’s Medicaid program will lose approximately 90 percent of its federal funding.”

The letter goes on to point out the importance not only of providing immediate additional funding but of ending the pattern of responding to frequent Medicaid cliffs.

“[The Medicaid and CHIP Payment and Access Commission (MACPAC) has noted that] the current financing structure based on short-term infusions makes it ‘difficult for territories officials to plan, manage, and sustain long-term, reliable access to care for Medicaid beneficiaries,’ ” the letter stated, adding that “[t]o address this concern, we request that the Committee work with the Government of Puerto Rico to secure a long-term, sustainable solution that eliminates the need for stop-gap measures and ensures stability for our fellow Americans on the island.”

The letter concludes, “In light of the pending deadline, we request the Committee’s urgent action to address this matter and stand ready to work with you. Thank you for your attention to this important matter.”

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